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  • Image not available. Glucocorticoid secretion from the adrenal cortex is stimulated by adrenocorticotropic hormone (ACTH) or corticotropin that is released from the anterior pituitary in response to the hypothalamic-mediated release of corticotropin-releasing hormone (CRH).
  • Image not available. To ensure the proper treatment of Cushing's syndrome, diagnostic procedures should (1) establish the presence of hypercortisolism and (2) discover the underlying etiology of the disease.
  • Image not available. The rationale for treating Cushing's syndrome is to reduce the morbidity and mortality resulting from disorders such as diabetes mellitus, cardiovascular disease, and electrolyte abnormalities.
  • Image not available. The treatment of choice for both ACTH-dependent and ACTH-independent Cushing's syndrome is surgery, whereas pharmacologic agents are reserved for adjunctive therapy, refractory cases, or inoperable disease.
  • Image not available. Pharmacologic agents that may be used to manage the patient with Cushing's syndrome include steroidogenesis inhibitors, adrenolytic agents, neuromodulators of ACTH release, and glucocorticoid-receptor blocking agents.
  • Image not available.Spironolactone, a competitive aldosterone receptor antagonist, is the drug of choice in bilateral adrenal hyperplasia (BAH)-dependent hyperaldosteronism.
  • Image not available. Addison's disease (primary adrenal insufficiency) is a deficiency in cortisol, aldosterone, and various androgens resulting from the loss of function of all regions of the adrenal cortex.
  • Image not available. Secondary adrenal insufficiency usually results from exogenous steroid use, leading to hypothalamic-pituitary-adrenal (HPA)-axis suppression followed by a decrease in ACTH release, and low levels of androgens and cortisol.
  • Image not available. Virilism results from the excessive secretion of androgens from the adrenal gland and often manifests as hirsutism in females.

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On completion of the chapter, the reader will be able to:

++

  • 1. Describe the roles of the various zones of the adrenal cortex in hormone synthesis.
  • 2. Explain the regulation of glucocorticoid, adrenal androgen, and mineralocorticoid secretion.
  • 3. Describe and differentiate the various etiologies of Cushing's syndrome.
  • 4. Interpret the results of laboratory tests used to diagnose Cushing's syndrome.
  • 5. Compare and contrast therapeutic regimens for treatment of Cushing's syndrome, based on the etiology of the disease in a particular patient.
  • 6. Discuss the methods of, and rationale behind, steroid replacement in the treatment of adrenal adenoma.
  • 7. Explain the difference between primary and secondary aldosteronism.
  • 8. Interpret the results of laboratory tests used to diagnose primary aldosteronism.
  • 9. Recommend a therapeutic regimen for treatment of primary aldosteronism, based on the etiology of the disease in a particular patient.
  • 10. Compare and contrast the symptoms and presentation of patients with primary and secondary adrenal insufficiency.
  • 11. Construct a treatment plan for a patient with acute adrenal insufficiency.
  • 12. Describe how specific enzyme deficiencies lead to congenital adrenal hyperplasia.
  • 13. List several options for the treatment of hirsutism.
  • 14. Discuss some of the potential side effects of systemic glucocorticoid use, and how the risk of developing these side effects can be minimized.
  • 15. Recommend appropriate counseling points for a patient initiating long-term glucocorticoid therapy.

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The adrenal glands were first characterized by Eustachius in 1563. After Addison identified a case of adrenal insufficiency in humans, adrenal anatomy and physiology flourished. Most of the work done in the early and mid-1900s centered ...

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